Provider Demographics
NPI:1437698065
Name:KAGOMA, YOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YOAN
Middle Name:
Last Name:KAGOMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MAIN STREET WEST
Mailing Address - Street 2:HSC-2S23: DEPARTMENT OF RADIOLOGY
Mailing Address - City:HAMILTON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L8N3Z5
Mailing Address - Country:CA
Mailing Address - Phone:905-521-2100
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:ROOM H1307
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1475342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology